Healthcare Provider Details

I. General information

NPI: 1619146966
Provider Name (Legal Business Name): CLAUDIO PEREZ-LEDEZMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E LOHMAN AVE STE B
LAS CRUCES NM
88011-8268
US

IV. Provider business mailing address

3821 MASTHEAD ST NE
ALBUQUERQUE NM
87109-4679
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5752
  • Fax: 575-522-5722
Mailing address:
  • Phone: 505-998-7401
  • Fax: 505-998-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2009-0775
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01078003A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2009-0775
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: